Some things that have come out of this are really shocking to me, Mr. Deters said. Like billing for a private room when the patient was in a semiprivate room, and not returning overpayment on a bill. And a lack of proper training for people in the billing department.

He said every claim in the suit has been documented to him by a witness from the hospital's billing office. This person came forward and provided all the information we used in the complaint, he said.

The suit charges that St. Elizabeth routinely fails to try to properly bill the patient's insurance and then bills the patient. The suit claims this leads to aggressive bill-collection tactics by collection agencies working on the hospital's behalf.

Among the plaintiffs are Mary and John Blythe of Florence. Mary Blythe won a $100,000 judgment against St. Elizabeth Medical Center in January. The hospital appealed the judgment, and the suit claims that collection agents are still trying to collect medical bills from Ms. Blythe.

Other plaintiffs alleged that the hospital improperly billed their insurance and/or Medicare and then referred the matter to a collection agency and eventually a lawyer.

This (suit) is not about people not wanting to pay their hospital bills, Mr. Deters said. It's about improper practices by the medical center resulting in emotional and financial stress for these people.

St. Elizabeth spokeswoman Carla Webb said Thursday that the hospital administration had not seen a copy of the suit and therefore could not comment.

The suit, which seeks compensatory and punitive damages and asks for a jury trial, contains a total of 18 counts against the hospital.